Hematological Scoring System Research Articles

Validity of Hematological scoring system in diagnosis of neonatal sepsis at Birat Medical College Teaching Hospital

Introduction: Newborns are vulnerable to infections. Timely diagnosis of neonatal sepsis can avoid major morbidity and mortality. Neonates with sepsis present with non-specific signs and symptoms. Timely diagnosis is important. Though blood culture is gold standard, it consumes time. Hematological scoring system (HSS) using hematological parameters can be effective in early diagnosis of sepsis. Objectives: To evaluate the effectiveness (Sensitivity, specificity, Positive Predictive value (PPV), Negative Predictive value (NPV) of HSS and their individual parameters in diagnosis of neonatal sepsis. Methodology: This was the cross-sectional study done at tertiary care hospital for period of six months. Neonates with clinical suspicion of sepsis were included in the study. Blood was drawn from neonate in two vials, one was sent for culture and other for calculation of hematological parameters as per Rodwell Hematological scoring system. Diagnostic study parameters were calculated. Result: Total of 143 neonates clinically suspected of sepsis were included in the study with 83 having positive blood culture. Highest sensitivity (86.7%) was recorded for Total Polymorph neutrophil (PMN) while highest specificity (93.3) and PPV (81.8) for I: T PMN ratio. A sensitivity of 67.5% and specificity of 91.7% was seen along with PPV of 91.8% and NPV of 67.1% with HSS greater than or equal to 5. Conclusion: HSS of greater than or equal to 5 can be considered to be the reliable screening tool for diagnosis of sepsis.

Role of Hematological Parameters in the Early Diagnosis of Neonatal Sepsis.

The major cause of neonatal mortality and morbidity is bacterial sepsis. Blood culture is the most reliable method in neonatal sepsis. This study was conducted to study the usefulness of hematological parameters in the early diagnosis of neonatal sepsis and to assess the most sensitive and specific variables in diagnosing neonatal sepsis. This prospective study was conducted in a tertiary care hospital from January 2017 to January 2018. Peripheral blood smears were prepared from patients with clinical suspicion of sepsis or predisposing perinatal factors for sepsis and stained with Field's stain and examined. The hematological findings were analyzed according to the hematologic scoring system of Rodwell. It was found that immature PMN count, I: M ratio, and I: T ratio had the highest sensitivity (92.06%, 87.30%, and 74.60%, respectively) while I: M ratio, I: T ratio, and degenerative changes in PMN had the highest specificity (97.50%, 96.50%, and 94.0%, respectively) in the prediction of sepsis.

Utility of clinico-hematological risk assessment and severity score (chase score) in covid-19 patients

Treating COVID-19 during pandemic situations is a challenge to utilize the resources judiciously. A proper triage and prognostication are very helpful. We aim to formulate a combined clinico-hematological scoring system in COVID – 19 patients and check its utility in prognostication in terms of mortality and development of complications in COVID-19 patients. This retrospective cross-sectional study included patients that were admitted to CDSIMER for treatment. Demographic, clinical, laboratory and outcome data were extracted from the respective patient files stored at medical records department. We formed a clinico hematological scoring system that included 8 parameters and each parameter was scored as 1 or 2. Based on total score (range 8 to 16) obtained they were categorized into low risk and high risk for treatment outcomes.We studied data of 451 COVID-19 patients admitted in CDSIMER from April 2021 to July 2021. We observed 100% recovery in the patients with score 8, 9 and 10. The mortality began to appear from score 11 onwards, showing increasing trend of mortality with higher scores. Therefore, score of ≥ 11 was established as the cut off to determine high risk for mortality. Out of the total 451 COVID patients, 70.10% (n=316 cases) came under the high-risk category, out of which 13.60% (n=43) had mortality and despite high risk as many as 86.40% patients (n=273) recovered with or without complications. Low risk category had demonstrated 100% (n=351) recovered cases. The p value was significant (0.00) on comparing the outcomes in the two categories of the proposed scoring system. Chase score is a novel scoring system easy and feasible to use in any hospital setting. The score helps clinicians to triage patients at admission to determine the standard of care, the need to carry out selective follow up investigations but not compromising in implementing the standard of care. Future prospective studies which can measure the internal and external validity of the score is very important.

Evaluation of haematological scoring system as a screening tool for early detection of neonatal sepsis

Background: Early diagnosis of neonatal septicemia is a vexing problem because of its nonspecific clinical picture. Hence the timely diagnosis of sepsis in neonates is critical as the illness can be rapidly progressive and, in some instances, fatal. The current study was undertaken to assess the significance of the hematological scoring system (HSS) for early detection of neonatal sepsis. Objectives were to assess the effectiveness of HSS in early detection of neonatal sepsis by comparing it with blood culture result, in neonates who were clinically suspected to have bacterial infection Methods: This is a descriptive study done in TDMCH, Vandanam for a period of 1 year. All babies who were at risk of developing sepsis were studied after applying inclusion and exclusion criteria. Blood samples were collected and subjected to sepsis work up. HSS scoring was done. Sensitivity, specificity, positive predictive value (PPV), Negative predictive value (NPV) of HSS and each of its components were calculated. Results: Among the 85 neonates studied, 39 (45.9%) were blood culture positive, 42 (49.4%) had HSS score of 5 or more. HSS score had sensitivity of 92.31%, specificity of 86.96%, PPV of 85.71% and NPV of 93.02%. Conclusions: HSS score of ≥5 had high NPV and would play a major role in ruling out neonatal sepsis.

ROLE OF HEMATOLOGICAL SCORING SYSTEM IN DIAGNOSIS OF NEONATAL SEPSIS

Introduction: Neonatal sepsis is a clinical syndrome resulting from pathophysiologic effects of local and systemic infection in the 1st month of life. Septicemia usually consists of bacteremia with a constellation of signs and symptoms caused by microorganisms or their toxic products in the circulation. Neonatal sepsis was one of the common causes of neonatal mortality, contributing to 16% of all intramural deaths. Early diagnosis of neonatal septicemia is a vexing problem because of its nonspecific clinical picture. Method: This study was prospective observational study of 210 Cases received from August 2020 to August 2022 for Neonatal Sepsis. This prospective study was carried out in Department of Pathology of a tertiary care teaching hospital. The ethical permission has been obtained from Institutional Ethics Committee for conducting the study. Hemogram was obtained for each case using five part automated hematology analyser. Result: Hematological scoring system was useful test in the early diagnosis of neonatal sepsis. Diagnostic accuracy was 92.39% in this study,>=3 score was sensitive and >=4 score was specific for early diagnosis of neonatal sepsis Conclusion: The HSS increases the diagnostic accuracy of the complete blood cell count as a screening test for sepsis and simplifies and standardizes its interpretation.

Diagnostic Accuracy of Haematological Scoring System in Paired cord Blood and Peripheral Venous Blood for early Detection of Neonatal Sepsis – A Prospective Analytical Study

Introduction: Sepsis is one of the major causes of neonatal morbidity and mortality. Early recognition and diagnosis of early onset neonatal sepsis (EONS) is difficult. Hence, there is a need for early predictive screening method for EONS, for which Haematological Scoring System (HSS) is used. It comprises of total leucocyte count, immature / total neutrophil ratio, total PMN count, immature PMN count, degenerative changes in PMN and platelet count.
 Methods: 100 inborn neonates with two or more risk factors for EONS, chosen by sequential sampling method were included in this prospective analytical study. Blood samples were collected from umbilical cord and peripheral vein and analysed for haematological parameters. Blood cultures were performed as gold standard for diagnosing neonatal sepsis and sepsis screen was done to corroborate the diagnosis of EONS.
 Results: Out of 100 neonates, 21 had sepsis, 14 had probable sepsis and 65 had no sepsis. Among the variables of HSS it was observed that elevated I:T ratio, thrombocytopenia, elevated I:M ratio and elevated immature neutrophil count have shown significant correlation with EONS with statistically significant p values (p value < 0.05), with raised I:T ratio being highly sensitive in identifying neonatal sepsis and degenerative changes in neutrophils being highly specific.
 Conclusions: The HSS was found to be satisfactory in identifying EONS. It can be used as a simple, quick, cost effective and readily available screening test with decent sensitivity and high specificity, for detection of EONS.

Diagnostic Evaluation of Modified Hematological Sepsis Score and Presepsin in Neonatal Sepsis

Abstract Background Early diagnosis of neonatal sepsis and assessment of the severity of the disease is not yet effectively achieved. Some hematological parameters are used to formulate a hematological scoring system (HSS) and a modified hematological scoring system(MHSS), for diagnosis of neonatal sepsis. A promising biomarker is Presepsin, or Soluble Cluster of Differentiation 14 SubType (sCD14-ST), which is a proteolysis product of CD14, that is produced after immune activation during infections. Aim of the Work To evaluate the performance of both HSS, MHSS and serum presepsin level, in neonatal sepsis, and compare them to C-reactive protein (CRP) as diagnostic tools and predictors of mortality. Methods The study was divided into two groups, one group comprised 51 neonates who further subgrouped into suspected & proved sepsis, along with 30 neonates who were admitted for non-infectious causes who served as control group. Both groups were subjected to calculation of HSS, MHSS, serum presepsin levels, CRP measurement, blood culture and, assessed for clinical severity and mortality. Results Hematological sepsis scores and presepsin levels were significantly higher in sepsis group. Presepsin showed the best diagnostic performance at > 0.5 ng/ml (AUC 0.979; sensitivity of 94.1% and specificity of 100%). While HSS and MHSS at a cutoff value > 1 achieved comparable specificity but lower sensitivity, 72.6% for the former and 76.5% for the later. Presepsin also was significantly higher in died group with the best predictive performance over CRP at cut-off value >1.9 ng/ml (AUC 0.83; sensitivity of 85.7% and specificity of 79.6%) Conclusions Hematological sepsis scores and presepsin were found to be useful diagnostic tools in neonatal sepsis with presepsin as a good predictor of mortality comparable to CRP. Disclosure: The authors declare that they have no conflict of interest.

A novel nomogram based on the hematological prognosis risk scoring system can predict the overall survival of patients with hepatocellular carcinoma.

This study aimed to establish and validate a nomogram based on a hematological prognostic risk scoring system to predict the overall survival in patients with unresectable hepatocellular carcinoma (HCC). Patients diagnosed with unresectable HCC undergoing transcatheter arterial chemoembolization (TACE) in 2012-2016 and 2017-2018 were included in the development set and validation set, respectively. The clinical outcome was overall survival (OS). The LASSO regression analysis was used to construct a hematological prognostic risk scoring system (HPR) by using the 18 hematological markers of patients in the development set. Combining the features of oncology on the basis of HPR to construct a nomogram for OS. In the development set and validation sets, the C-index, calibration curve, and decision curve analysis (DCA) were used to evaluate the prediction performance of the nomogram. Multiple markers of immunity, coagulation, liver function, and nutrition, including red blood cell distribution width-coefficient of variation (RDW-CV), platelet (PLT), aspartate transferase (AST), alkaline phosphatase (ALP), prognostic nutritional index (PNI), and fibrinogen (Fib), construct the HPR. HPR was an independent risk factor for OS in patients with HCC. The C-index of the nomogram was 0.731 (95% confidence interval (CI) 0.712-0.749) and 0.696 (95% CI 0.668-0.725) in the development set and the validation set, respectively. HPR was a complement to the clinical features of patients with unresectable HCC. The nomogram based on HPR proved to be a practical and effective method for prognosticating HCC patients who undergo TACE.

Hematological Scoring System and its Correlation with Blood Culture, C-reactive Protein, and Micro-erythrocyte Sedimentation Rate in Early Diagnosis of Neonatal Sepsis

BACKGROUND: Neonatal sepsis is a major health problem in our country. The cause for most of the deaths is not a failure to treat the infection, instead, it is the failure to treat it on time. Sepsis is usually identified by a gold-standard blood culture test. However, there is a need for a simple and cost-effective diagnostic tool with quick results. MATERIALS AND METHODS: A total of 70 neonates with clinical suspicion of sepsis were included in our study. The hematological parameters such as total leukocyte count(TLC), absolute neutrophil count (ANC), platelet count, immature neutrophil count, immature to total neutrophil ratio (I:T), immature to mature neutrophil ratio (I:M), toxic granules, and cytoplasmic vacuolation in neutrophil were correlated with C-reactive protein (CRP), blood culture and micro-erythrocyte sedimentation rate (micro-ESR). The performance of these hematological parameters was evaluated with the help of hematological scoring system (HSS). RESULTS: Among the hematological parameters, TLC has high sensitivity (77.8%) and specificity (72.1%), ANC has the least sensitivity (44.4%) but the highest specificity (96.7%), platelet count has high sensitivity (88.9%) but low specificity (44.3%), I:T and I:M ratio have the highest sensitivity (88.9% both), specificity (71.1% and 88.5%, respectively) and negative predictive value (91.3% and 92.8% respectively). ANC and I:M ratios have the highest positive predictive value (89.3% and 82.5%, respectively) in predicting the early diagnosis of neonatal sepsis. CONCLUSION: HSS along with CRP and micro-ESR can be used as a screening tool in neonates with clinical suspicion of sepsis as they are simple to perform, and can be done even in rural parts of the country.

Utility of Hematological Parameters in Early Diagnosis of Neonatal Sepsis in Comparison to C-Reactive Protein

Abstract Background Neonatal sepsis is the most common cause of neonatal mortality and morbidity. As neonatal sepsis presents with subtle symptoms and signs, decision to start empirical antibiotics is most often based on risk profile. Hematological parameters and C-reactive protein (CRP) are routinely done as a part of sepsis screening, but isolation of microorganism on blood culture is the gold standard for diagnosis of sepsis. Methodology One-hundred neonates with suspected sepsis were studied and their hematological parameters, hematological scoring system (HSS), and CRP were correlated to blood culture. Results Among the study population, immature to total neutrophil count (I:T) ratio had the best sensitivity (94.1%) and negative predictive value (83.3%), followed by HSS with a sensitivity of 64.7% and negative predictive value of 68.4%, whereas CRP was more specific (75.9%). Conclusion HSS and CRP are good predictors of diagnosis of neonatal sepsis. I:T ratio had the best sensitivity and negative predictive value.

Haematological Scoring System: An Early Predictor of Newborn Sepsis as Compared to Blood Culture at tertiary care centre

Background: Newborn sepsis is a clinical syndrome characterised by infection-related signs and symptoms in the first month of life, with or without bacteraemia. Sepsis is defined by the Brazilian Health Surveillance Agency (ANVISA) as a systemic reaction with at least two or more of the following signs and symptoms: thermal instability, bradycardia, apnea, intolerance, worsening of respiratory discomfort, hypoactivity and lethargy. Materials and Methods: This cross-sectional study was conducted in the Bal Chikitsalaya, M. B. Government Hospital, Udaipur (Rajasthan). A total of 100 sample sizes were included in between 6-month periods from March 2019 to August 2019. Blood culture reports were compared to haematological scoring parameters, C-reactive protein (CRP) levels, and other factors. Results: 27% of the 100 cases under investigation had positive blood cultures. There were 65% male. 35% of neonates had very low birth weights and 60% were premature. 74% of cases of septicemia had an early onset, compared to 26% of cases with a late onset. In 37.1% of cases, klebsiella was the most frequent organism identified, followed by E. coli and Coagulase Positive Staphylococcus. It has a higher sensitivity and a lesser specificity. The PPV range of the haematological grading criteria was 47% to 65%. C-reactive protein has extremely high sensitivity (81.5%) and extremely low specificity (9.6%), respectively. Conclusion: The early diagnosis of newborn sepsis can be made with the help of the Haematological Scoring System (HSS), which is a rapid, easy-to-use, readily accessible, bedside, cost-effective diagnostic. As opposed to blood cultures, haematological scoring factors are effective early diagnostic and treatment tools. Since the indicators have excellent sensitivity and specificity, antibiotics can be administered to asymptomatic patients with negative culture results. The accuracy of the sepsis diagnosis is improved.

Haematological Scoring System: An Early Predictor of Newborn Sepsis as Compared to Blood Culture at tertiary care centre

Haematological Scoring System: An Early Predictor of Newborn Sepsis as Compared to Blood Culture at tertiary care centre

The Role of Salivary C-Reactive Protein in Diagnosis of Neonatal Sepsis

Background Neonatal sepsis remains one of the leading causes of morbidity and mortality among neonates. Objective to evaluate the role of salivary C-reactive protein (CRP) as a diagnostic marker in neonatal sepsis. Methods This case-control study was carried out on 90 neonates including 45 neonates with symptoms and signs suggestive of neonatal sepsis and 45 healthy neonates as controls. All neonates were subjected to full history taking, thorough clinical examination, laboratory investigations including complete blood count (CBC), serum CRP, blood culture, and salivary CRP. Results Septic neonates showed significantly higher salivary CRP compared to controls; it was significantly associated with positive serum CRP, blood culture, and hematological scoring system (HSS). It was significantly higher in neonates who died compared to those who survived. Twenty one cases with positive salivary CRP showed significant positive correlations with the length of the neonatal intensive care unit stay, total white blood cell (WBC) count, mean platelet volume (MPV), neutrophils to lymphocytes ratio (NLR), serum CRP, HSS, significant negative correlations with gestational age, birth weight, APGAR at 1, 5 min, and platelet count. Receiver operating characteristic (ROC) curve for salivary CRP showed that at cut-off value of 0.135 mg/L, the sensitivity was (81.8%) and the specificity was (75.6%) for detecting neonatal sepsis. Conclusion Salivary CRP was significantly higher in the septic group, and was associated with positive serum CRP. Hence, salivary CRP could be considered a novel non-invasive biomarker for diagnosing neonatal sepsis.

A prospective study on reliability and effectiveness of different hematological parameters for early diagnosis of neonatal sepsis in a tertiary care hospital of sub-Himalayan region

Background: Neonatal sepsis is a major cause of morbidity and mortality in newborn.Early diagnosis of neonatal sepsis is the top priority to all clinicians for early initiation of appropriate treatment which will reduce the morbidity and mortality in neonates and minimizes the unnecessary antibiotic therapy which will lead to overwhelming threat of multidrug-resistant organism. Aims and Objectives: The recent study was undertaken to study the reliability and effectiveness of hematological parameters and Rodwell’s hematological score for early diagnosis of sepsis in neonates. Materials and Methods: In this study,212 neonates were studied out of which 88 were blood culture proven sepsis and 39 were culture negative but hematological parameters positive probable sepsis.The rest 85 were both culture negative and hematological parameter negative and were considered normal baby and taken as control group in this study. Hematological parameters were studied in all cases included in the study which include total leukocyte count, absolute neutrophil count, immature/total neutrophil ratio, platelet count, C-reactive protein (CRP), and other components of Rodwell’s scoring criteria. Recent statistical analysis of all the components and hematological scoring system (HSS) done to find out the reliability and effectiveness. Results: Analysis of hematological parameters showed that absolute neutrophil count, immature to total neutrophil ratio and platelet count have a better sensitivity and specificity in relation to other parameters.CRP and total leukocyte count have better specificity but sensitivity was very low.In the HSS, it has been shown that this scoring system was highly sensitive and specific with a high positive predictive value and negative predictive value.Among the different parameters studied, association of total leukocyte count(P<0.0001)and reduced platelet count(P<0.0001) is the most consistent indicator found in this study but association with CRP was found to be statistically insignificant(P=0.0703). Conclusion: HSS system, total leukocyte count, absolute neutrophil count and platelet count are very reliable indicator for early diagnosis of neonatal sepsis which is cheap, simple, less time consuming, and cost effective.

Usefulness of Haematological Scoring System in Early Diagnosis of Neonatal Sepsis

Background: Neonatal sepsis is one of the major causes of morbidity and mortality of the new born, especially in developing countries. The major concerns of the clinicians are its non-specific presentation and unavailability of tests with a high predictive value. Therefore, the need is for an infallible test that can be easily performed, quick, simple and cost-effective. Objectives: To assess the reliability of Haematological scoring system in diagnosis of suspected neonatal sepsis at early stage. Materials and Methods: A total of 84 suspected cases of neonatal sepsis were included in this prospective cross-sectional study carried out in Khulna City Medical College Hospital during the period from July 2021 to June 2022. The peripheral blood smears from all 84 patients were analysed using HSS of Rowell et al by pathologists. HSS assigns a score of 1 for each of seven findings significantly associated with sepsis such as total leukocyte count, total polymorphonuclear neutrophil count, elevated immature PMN count, elevated immature: total PMN ratio, Immature: mature PMN ratio >0.3, platelet count <150000/cmm, and pronounced degenerative or toxic changes in PMNs. The HSS score of >5 was interpreted as sepsis, blood culture was done as gold standard for diagnosis of sepsis. Each haematological parameter was assessed for its individual performance and sensitivity, specificity, positive and negative predictive values were calculated. Results: Among the total 84 suspected cases, 20 cases were diagnosed neonatal sepsis, (23.8%), 31 cases had probable infection (36.9%), and 33 cases were normal (39.3%). Elevated immature: total PMN count ratio (>0.2) and Immature: Mature PMN ratio (>0.3) were the most sensitive and specific parameter for sepsis. It was also seen that with increasing score, the likelihood of sepsis also increases. Conclusion: The sensitivities and specificities of the various parameters of HSS were found to be satisfactorily significant in identifying ........

Hematological Prognostic Scoring System Can Predict Overall Survival and Can Indicate Response to Immunotherapy in Patients With Osteosarcoma.

Osteosarcoma is the most common primary malignant bone tumor with a high metastatic potential. Nowadays, there is a lack of new markers to identify prognosis of osteosarcoma patients with response to medical treatment. Recent studies have shown that hematological markers can reflect to some extent the microenvironment of an individual with the potential to predict patient prognosis. However, most of the previous studies have studied the prognostic value of a single hematological index, and it is difficult to comprehensively reflect the tumor microenvironment of patients. Here, we comprehensively collected 16 hematological markers and constructed a hematological prognostic scoring system (HPSS) using LASSO cox regression analysis. HPSS contains many indicators such as immunity, inflammation, coagulation and nutrition. Our results suggest that HPSS is an independent prognostic factor for overall survival in osteosarcoma patients and is an optimal addition to clinical characteristics and well suited to further identify high-risk patients from clinically low-risk patients. HPSS-based nomograms have good predictive ability. Finally, HPSS also has some hints for immunotherapy response in osteosarcoma patients.

Diagnostic Evaluation of Hematological Sepsis Score and Presepsin in Neonatal Sepsis

Background: Early detection of neonatal sepsis and categorization of patients based on clinical severity is not yet effectively achieved. Some hematological parameters are used to formulate a hematological scoring system (HSS) and a modified hematological scoring system (MHSS) to diagnose neonatal sepsis. A promising biomarker: Presepsin, or Soluble Cluster of Differentiation 14 SubType (sCD14-ST), is a proteolysis product of CD14 produced after immune activation during infections. The purpose of this research is to assess the performance of both hematological sepsis scores and serum presepsin level in neonatal sepsis and compare them to C-reactive protein (CRP) as diagnostic tools and predictors of mortality.
 Materials and Methods: This case-control study comprised two groups, one group comprised 51 neonates who were further subgrouped into suspected & proved sepsis, along with 30 uninfected neonates as the control group. Both groups were subjected to the calculation of HSS and MHSS, serum presepsin levels, CRP measurement, and blood culture and assessed for clinical severity and mortality.
 Results: Hematological sepsis scores and presepsin levels were significantly higher in the sepsis group (P <0.001). Presepsin showed the best diagnostic performance at > 0.5 ng/ml (AUC 0.979; sensitivity of 94.1% and specificity of 100%). While HSS and MHSS at a cutoff value > 1 achieved comparable specificity, lower sensitivity, 72.6% for the former and 76.5% for the later was noted. Presepsin also was significantly higher in the dead group (P<0.004) with the best predictive performance over CRP at cutoff value >1.9 ng/ml (AUC 0.838; sensitivity of 85.7% and specificity of 79.6%).
 Conclusion: Hematological sepsis scores and presepsin were useful diagnostic tools in neonatal sepsis, with presepsin as a good predictor of mortality comparable to CRP.

Comparative assessment of umbilical cord blood with peripheral venous blood using hematological scoring system as an early predictive screening method for the detection of early-onset neonatal sepsis in the tertiary care center of Central India

Background: Sepsis is one of the major causes of neonatal morbidity and mortality. Early recognition and diagnosis of early-onset neonatal sepsis (EONS) is difficult because of the variable and non-specific clinical presentation of this condition. Hence, there is a need for early predictive screening method for EONS. Aims and Objectives: To compare the umbilical cord blood Haematological Scoring System (HSS) with peripheral venous blood as an early predictive screening method for detection of EONS. Materials and Methods: 100 inborn neonates with two or more risk factors for EONS, chosen by sequential sampling method were included in this prospective analytical study. Blood samples were collected from the umbilical cord and peripheral vein analyzed for hematological parameters, sepsis screen, and peripheral smear for HSS of Rodwell et al., send for blood culture. Blood cultures were performed as gold standard for diagnosing neonatal sepsis and sepsis screen was done to corroborate the diagnosis of neonatal sepsis. Results: Of 100 neonates, 21 belongs to sepsis; 14 to probable sepsis; 65 to no sepsis. HSS in umbilical cord blood (UCB) had Sensitivity-74.28%, Specificity-92.30%, PPV-83.87%, NPV-86.95% and HSS in PVB had Sensitivity-62.85%, Specificity- 87.69%, PPV-75.86%, NPV-81.69%. Conclusion: HSS score in UCB can be used as a simple, quick, cost-effective, and readily available screening test with decent sensitivity and high specificity, for the detection of EONS.

Amyloidosis Composite Response Score Incorporating the Depth of Organ Response

Background:Systemic light chain (AL) amyloidosis is a plasma cell disorder characterized by multisystem deposition of misfolded immunoglobulin light chains produced by clonal plasma cells. Hematologic and organ responses with treatment have been shown to correlate with survival as early as 3 months from initiation of first-line treatment. Our group recently developed and validated a model integrating organ and hematologic responses for assessment of treatment outcomes at 6 months. Although current organ response criteria do not consider the depth of organ response, this has been shown to have prognostic utility in newly diagnosed patients. So, we designed this study to evaluate a composite hematologic and organ scoring system that also considers the depth of organ response at 1 to 6 months from initiation of first-line treatment.Methods:We included patients with AL amyloidosis who had at least one major organ involvement (cardiac, renal and/or liver involvement) and who had not started a second line treatment by 6 months from the time of initiating first-line treatment. For each patient, we calculated an organ response score and a hematologic response score at 1, 2, 3, 4, 5, and 6 months from initiation of first-line treatment. A score was assigned for each depth of hematologic response as follows: complete response=0, very good partial response=1, partial response=2, and no response/progressive disease=3). To calculate organ response, a score was assigned to each organ based on the depth of organ response (Muchtar et al. 2018): non-evaluable=0, complete response=1, very good partial response=2, partial response=3, and no response=4. The final organ response score was obtained by calculating the average of the individual involved organ scores. We then calculated the composite hematologic and organ response (HOR) score by adding the organ and hematologic responses at each interval and compared overall survival (OS) between patients with HOR score ≤ 5 (group 1) and those with score > 5 (group 2).Results:The cohort included 730 patients diagnosed with AL amyloidosis between February 10 th, 2006 and July 9 th, 2019. Median age was 63 (IQR: 56-69), and 65% were male. The involved light chain was Lambda in 75% of cases. Cardiac, renal, and liver involvement were found in 81%, 61%, and 17% of patients, respectively. Among all patients, 28% underwent autologous stem cell transplantation during their disease course. The median follow up in the entire cohort was 7.0 (95%CI: 6.4-8.0) years and OS was 3.6 (95%CI: 2.6-4.4) years. At 1 to 4 months, we observed a statistically significant difference in OS between patients with HOR score ≤5 vs. >5. However, there was no difference in OS between the 2 groups at 5 and 6 months. These results are presented in Table 1.Conclusion:A composite hematologic and organ response score that takes into consideration the depth of organ response can discriminate 2 groups of patients with distinct survival outcomes as early as 1 month from treatment initiation and maintains its predictive ability for up to 4 months. The lack of predictive ability beyond 4 months in this study may be due to limited sample size especially in group 2 as more patients achieve deeper responses with time. This approach can provide the basis for early changes in treatment but needs validation in future studies. [Display omitted] DisclosuresDispenzieri: Janssen: Consultancy, Research Funding; Takeda: Research Funding; Sorrento Therapeutics: Consultancy; Oncopeptides: Consultancy; Pfizer: Research Funding; Alnylam: Research Funding. Gertz: Ionis Pharmaceuticals: Other: Advisory Board; Akcea Therapeutics, Ambry Genetics, Amgen Inc, Celgene Corporation, Janssen Biotech Inc, Karyopharm Therapeutics, Pfizer Inc (to Institution), Sanofi Genzyme: Honoraria; Aurora Biopharma: Other: Stock option; Akcea Therapeutics, Alnylam Pharmaceuticals Inc, Prothena: Consultancy; AbbVie Inc, Celgene Corporation: Other: Data Safetly & Monitoring. Kapoor: Ichnos Sciences: Research Funding; Karyopharm: Consultancy; Glaxo SmithKline: Research Funding; Pharmacyclics: Consultancy; Amgen: Research Funding; Cellectar: Consultancy; Sanofi: Consultancy; BeiGene: Consultancy; Regeneron Pharmaceuticals: Research Funding; Karyopharm: Research Funding; Sanofi: Research Funding; Takeda: Research Funding; AbbVie: Research Funding. Dingli: GSK: Consultancy; Sanofi: Consultancy; Janssen: Consultancy; Novartis: Research Funding; Apellis: Consultancy; Alexion: Consultancy. Kumar: Oncopeptides: Consultancy; Merck: Research Funding; Antengene: Consultancy, Honoraria; Bluebird Bio: Consultancy; Roche-Genentech: Consultancy, Research Funding; Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Research Funding; Novartis: Research Funding; Carsgen: Research Funding; Tenebio: Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; KITE: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Consultancy, Research Funding; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Beigene: Consultancy; Adaptive: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sanofi: Research Funding; Takeda: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding.

Use of hematological parameters as an early screening tool for neonatal sepsis

Background: Neonatal sepsis continues to be a major public health problem in developing countries. Due to the nonspecific clinical manifestations of neonatal sepsis, the longer turnaround time for culture reports, an early diagnostic tool is essential for the initiation of appropriate and timely treatment. Materials and Methods: This is a cross-sectional study of 470 clinically suspected cases of neonatal sepsis admitted in the pediatrics department of B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Following hematological parameters: abnormal total leucocyte count, abnormal total polymorphonuclear count, elevated immature Neutrophils count, elevated immature to total neutrophil ratio, immature to mature neutrophils ratio ≥ 0.3, platelet count ≤ 150,000/mm3, and pronounced degenerative changes in Neutrophils were assessed and a score of 1 was assigned to each as per the hematological scoring system of Rodwell. A score ≥ 3 was considered positive and a score < 3 was considered negative for the diagnosis of sepsis. Blood culture was taken as a gold standard for diagnosis of neonatal sepsis Results: Hematological scoring system had fairly high sensitivity, specificity, NPV, and PPV; i.e. 85.96%, 84.26%, 84.52%, and 85.71% respectively. The diagnostic accuracy of HSS was high (85.1%) in comparison to the maximum diagnostic accuracy of individual hematological parameters, i.e. 74.46% for the total neutrophil count. Conclusions: Hematological scoring system can be used as a convenient and early diagnostic tool against neonatal sepsis in developing countries with a high burden of neonatal sepsis because of its high sensitivity and easy availability.